Incidence rates, risk factors, and outcomes of aspiration pneumonia after gastric endoscopic submucosal dissection: A systematic review and meta‐analysis

Abstract

Background and Aim The risk and prognosis of aspiration pneumonia (AP) after endoscopic submucosal dissection (ESD) are inconsistent among studies. We aim to estimate the incidence, risk factors, and outcome of AP in patients after gastric ESD. Methods PubMed, EMBASE, Cochrane Library, and Web of Knowledge were searched for relevant articles from inception until April 2020. Data involving the incidence, risk factors, and outcomes were extracted. Pooled incidence, odds ratios (ORs), or standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated. Results Forty records involving 48 674 subjects were finally included. The pooled incidence of AP after gastric ESD was 1.9% (95% CI, 1.2–2.7) via the double arcsine transformation method and 1.6% (1.1–2.5%) via the logit transformation method. Risk factors analyses revealed that old age (OR, 2.52; 95% CI, 1.99–3.18), comorbid pulmonary disease (2.49; 1.66–3.74), comorbid cerebrovascular disease (2.68; 1.05–6.85), remnant stomach (4.91; 1.83–13.14), sedation with propofol (2.51; 1.48–4.28), and long procedural duration (count data: 5.20, 1.25–21.7; measurement data: 1.01, 1.01–1.02) were related to the occurrence of AP. Patients with AP had a longer hospital stay (SMD, 0.56; 95% CI, 0.25–0.87) than those without AP. Conclusions About 1.9% (1.2–2.7%) of the patients who receive gastric ESD may develop AP, resulting in prolonged hospital stay. More attention should be paid in patients who are older; have comorbidities such as pulmonary diseases, cerebrovascular diseases, or gastric remnant; or require a long procedural duration or deep sedation with propofol.

Fecal incontinence and oral regurgitation during duodenal endoscopic submucosal dissection using the water pressure method

“…For oral regurgitation, only tumor size was a significant related factor. The following factors have been reported as risk factors for aspiration pneumonia after gastric ESD: male, older age, comorbid lung disease, cerebrovascular disease, and postoperative stomach 19–21 . In this study, oral regurgitation occurred regardless of age or sex, and there were no cases with pulmonary disease, cerebrovascular disease, or postoperative stomach.…”

“…The following factors have been reported as risk factors for aspiration pneumonia after gastric ESD: male, older age, comorbid lung disease, cerebrovascular disease, and postoperative stomach. [19][20][21] In this study, oral regurgitation occurred regardless of age or sex, and there were no cases with pulmonary disease, cerebrovascular disease, or postoperative stomach. No other significant factors were found to be associated with oral regurgitation, suggesting that it may occur in WP-ESD regardless of patient factors.…”

“…In other gastrointestinal tracts, lesion size and resection time were usually considered to be proportional, and resection time was correlated with aspiration pneumonia. [20][21][22] However, in WP-ESD, oral regurgitation may occur regardless of the resection time. Gastric motility function is known to be temporarily decreased after gastric ESD.…”

“…In contrast to fecal incontinence, there was little association between oral regurgitation and gross appearance, saline volume in the body, resection time, or infusion speed. In other gastrointestinal tracts, lesion size and resection time were usually considered to be proportional, and resection time was correlated with aspiration pneumonia 20–22 . However, in WP‐ESD, oral regurgitation may occur regardless of the resection time.…”

Infections at the nexus of metabolic-associated fatty liver disease

“…Furthermore, COVID-19 patients show a higher occurrence of hepatic steatosis measured by thorax CT (Kreling et al 2020 ) and SARS-CoV and SARS-CoV-2 infections are often accompanied by abnormal levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) serum levels which suggest liver damage (Zhang et al 2020 ; Cui et al 2004 ). In addition, suffering from MAFLD increases the risk for developing severe COVID-19 in both diabetic and non-diabetic patients (Gao et al 2020 ; Dongiovanni et al 2020 ; Pan et al 2020 ).…”